Your body runs on fuel from sugar found in the foods you eat. While it’s a necessary energy source, too much added sugar can lead to health problems like obesity, type 2 diabetes, and high blood sugar.

Sugar’s bad rap has caused many people to reach for alternative ways to bring out the sweetness in their foods. The problem is sugar substitutes like xylitol come with side effects of their own.

What is xylitol? Xylitol is a type of artificial sweetener known as a sugar alcohol. Xylitol looks and tastes like sugar but has fewer calories. It’s found naturally in small quantities in some fruits and vegetables, but it is added in larger quantities to many everyday items like sugar-free gum and candies, toothpaste, and baked goods to enhance flavor and texture. It can also be found in products labeled “keto-friendly”. A new study published in the National Library of Medicine has linked high amounts of xylitol to increased risk of heart attack and stroke.

Xylitol and Heart and Stroke Risks

To help better understand what xylitol may mean for your cardiovascular health, we’ve asked cardiologist Ashesh Parikh, D.O. FACC, of Texas Health Physicians Group practice Texas Health Heart & Vascular Specialists, to weigh in. Before you dispose of everything you have on hand that contains the additive, Parikh explains that there are certain risk groups that should especially take note.

“It’s important to recognize that for the average person, xylitol intake isn’t a concern as of yet,” he says. “It is, however, for people who are at higher risk for heart disease, like diabetics, smokers, people on dialysis, and those who have had stents. There are choices when it comes to sweetening foods. Better options for those at higher risk are natural sugars like honey or fruit sugars, or sugar avoidance if at all possible.”

When you get a cut or bruise, platelets present in the bloodstream activate and clump up to seal the wound and prevent too much blood loss. What the study found was that higher levels of xylitol activated these platelets to start clumping.

“The problem is big clumps of platelets can clog up your arteries and lead to a lack of blood flow to places like the heart or brain,” according to Parikh. “Blood clots are the leading cause of heart attack and stroke.”

Why Xylitol Consumption Matters

So how much is too much when it comes to sugar substitutes? Artificial sweeteners like saccharin, Stevia, Splenda, and xylitol are generally safe in low quantities, Parikh says. “A packet or two of Splenda each day isn’t going to increase your risk for developing cardiovascular disease. But if you’re someone who consumes a lot of xylitol or another artificial sweetener, you may run into trouble.”

“When studies like this come out, we highlight the importance of healthier diet choices,” he adds. “No one wants to hear that they need to follow a super bland diet with essentially no carbohydrates. But when you’ve got heart disease or you’ve already had a stroke or your A1C parameter for diabetes is high, it’s what’s necessary to remain healthy.”

The Takeaways

If you struggle to reduce sugar in your diet, sugar substitutes may be a useful tool. However, Parikh cautions the use of artificial sweeteners as the primary alternative. “Perhaps the answer isn’t to replace sugar with artificial sweeteners but to find ways to incorporate more high-quality dietary components, like fruits and vegetables, for their naturally occurring sugars.”

Although the U.S. Food and Drug Administration doesn’t require food companies to list sugar alcohols on their ingredient lists, manufacturers must list them if the package labeling makes a statement about the health effects of sugar alcohols or sugars, or if the product is labeled “sugar-free” or “no added sugar”. So if you are looking to avoid or limit artificial sweeteners in your foods, you may be able to gauge their presence by the sugar alcohols listed on the Nutrition Facts labels of packaged goods.

Parikh says he advises his patients to take nutrition labels seriously and to use them as one tool for promoting overall health. “What is safe in the way of sugar or artificial sweeteners varies from person to person, but nutrition labels are a good starting point for dietary health. The diagnosis of heart disease or previous stroke is a lifelong diagnosis that requires a lifelong commitment to making healthier choices that limit disease progression,” he says.

Learn more tips about keeping your heart healthy at TexasHealth.org/Heart or take our five-minute heart health assessment to gauge your risks for heart disease.